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TABLE OF CONTENTS Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 What Is Alzheimer’s Disease? . . . . . . . . . . . . . . . . . . 2 What Are the Symptoms of Alzheimer’s Disease?. . . 3 General Safety Concerns . . . . . . . . . . . . . . . . . . . . . . 4 Is It Safe to Leave the Person with Alzheimer’s Disease Alone?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Home Safety Room by Room . . . . . . . . . . . . . . . . . . . 7 Home Safety Behavior by Behavior. . . . . . . . . . . . . 18 Special Occasions/Gatherings/Holidays . . . . . . . . . 23 Impairment of the Senses. . . . . . . . . . . . . . . . . . . . . 25 Driving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Warning Signs of Unsafe Driving. . . . . . . . . . . . . . . 31 Natural Disaster Safety. . . . . . . . . . . . . . . . . . . . . . . 32 Who Would Take Care of the Person with Alzheimer’s If Something Happened to You?. . . . . . 34 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Additional Resources . . . . . . . . . . . . . . . . . . . . . . . . 37


Home Safety for People with Alzheimer’s Disease

Introduction Caring for a person with Alzheimer’s disease is a challenge that calls upon the patience, creativity, knowledge, and skills of each caregiver. We hope that this booklet will help you cope with some of these challenges and develop creative solutions to increase the security and freedom of the person with Alzheimer’s in your home, as well as your own peace of mind. This booklet is for those who provide in-home care for people with Alzheimer’s disease or related disorders. Our goal is to improve home safety by identifying potential problems in the home and offering possible solutions to help prevent accidents. We begin with a checklist to help you make each room in your home a safer environment for the person with Alzheimer’s. Next, we hope to increase awareness of the ways specific impairments associated with the disease can create particular safety hazards in the home. Home safety tips are listed to help you cope with some of the more hazardous behaviors that may occur as the disease advances. We also include tips for managing driving and planning for natural disaster safety. The booklet ends with a list of resources for family caregivers.

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Home Safety for People with Alzheimer’s Disease

What Is Alzheimer’s Disease? Alzheimer’s disease is a progressive, irreversible brain disease that slowly destroys memory and thinking skills. Estimates vary, but experts suggest that as many as 5.1 million Americans have the disease, which affects people of all racial, economic, and educational backgrounds. Although Alzheimer’s primarily affects people age 60 or older, it also may affect people in their 50s and, rarely, even younger. Alzheimer’s disease is the most common cause of dementia in adults. Dementia is a loss of memory and intellect that interferes with daily life and activities. Dementia is not a disease; rather, it is a group of symptoms that may accompany certain diseases and conditions. Other symptoms include changes in personality, mood, or behavior. Other causes of irreversible dementia include vascular dementia and alcohol abuse. The recommendations in this booklet deal primarily with common problems in Alzheimer’s, but they also may be helpful for people with other types of dementia.

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Home Safety for People with Alzheimer’s Disease

What Are the Symptoms of Alzheimer’s Disease? There is no “typical” person with Alzheimer’s disease. There is tremendous variability among people with Alzheimer’s in their behaviors and symptoms. At present, there is no way to predict how quickly the disease will progress in any one person or the exact changes that will occur. We do know, however, that many of these changes will present problems for caregivers. Therefore, knowledge and prevention are critical to safety. People with Alzheimer’s disease have memory problems and cognitive impairment (difficulties with thinking and reasoning), and eventually they will not be able to care for themselves. They often experience confusion, loss of judgment, and difficulty finding words, finishing thoughts, or following directions. They also may experience personality and behavior changes. For example, they may become agitated, irritable, or very passive. Some people with Alzheimer’s wander from home and become lost. Others may not be able to tell the difference between day and night—they may wake up, get dressed, and start to leave the house in the middle of the night, thinking that the day has just started. People with Alzheimer’s also can have losses that affect vision, smell, or taste. These disabilities are very difficult, not only for the person with Alzheimer’s, but for the caregiver, family, and other loved ones as well. Caregivers need resources and reassurance to know that while the challenges are great, specific actions can reduce some of the safety concerns that accompany Alzheimer’s disease.

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Home Safety for People with Alzheimer’s Disease

General Safety Concerns People with Alzheimer’s disease become increasingly unable to take care of themselves. However, the disease progresses differently in each person. As a caregiver, you face the ongoing challenge of adapting to each change in the person’s behavior and functioning. The following general principles may be helpful. 1. Think prevention. It is very difficult to predict what a person with Alzheimer’s might do. Just because something has not yet occurred does not mean it should not be cause for concern. Even with the best-laid plans, accidents can happen. Therefore, checking the safety of your home will help you take control of some of the potential problems that may create hazardous situations. 2. Adapt the environment. It is more effective to change the environment than to change most behaviors. While some Alzheimer’s behaviors can be managed with special medications prescribed by a doctor, many cannot. You can make changes in an environment to decrease the hazards and stressors that accompany these behavioral and functional changes. 3. Minimize danger. By minimizing danger, you can maximize independence. A safe environment can be a less restrictive environment where the person with Alzheimer’s disease can experience increased security and more mobility.

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Home Safety for People with Alzheimer’s Disease

Is It Safe to Leave the Person with Alzheimer’s Disease Alone? This issue needs careful evaluation and is certainly a safety concern. The following points may help you decide. Does the person with Alzheimer’s: v become confused or unpredictable under stress? v recognize a dangerous situation, such as fire? v know how to use the telephone in an emergency? v know how to get help? v stay content within the home? v wander and become disoriented? v show signs of agitation, depression, or withdrawal when left alone for any period of time? v attempt to pursue former interests or hobbies that might now warrant supervision, such as cooking, appliance repair, or woodworking? You may want to seek input and advice from a health care professional to assist you in these considerations. As Alzheimer’s disease progresses, these questions will need ongoing evaluation.

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Home Safety for People with Alzheimer’s Disease

Home Safety Room by Room Prevention begins with a safety check of every room in your home. Use the following room-by-room checklist to alert you to potential hazards and to record any changes you need to make. You can buy products or gadgets necessary for home safety at stores carrying hardware, electronics, medical supplies, and children’s items. Keep in mind that it may not be necessary to make all of the suggested changes. This booklet covers a wide range of safety concerns that may arise, and some modifications may never be needed. It is important, however, to re-evaluate home safety periodically as behavior and abilities change. Your home is a personal and precious environment. As you go through this checklist, some of the changes you make may impact your surroundings positively, and some may affect you in ways that may be inconvenient or undesirable. It is possible, however, to strike a balance. Caregivers can make adaptations that modify and simplify without severely disrupting the home. You may want to consider setting aside a special area for yourself, a space offlimits to anyone else and arranged exactly as you like. Everyone needs private, quiet time, and as a caregiver, this becomes especially crucial. A safe home can be a less stressful home for the person with Alzheimer’s disease, the caregiver, and family members. You don’t have to make these changes alone. You may want to enlist the help of a friend, professional, or community service such as the Alzheimer’s Association. page 7


Home Safety for People with Alzheimer’s Disease

Throughout the Home w Display emergency numbers and your home address near all telephones. w Use an answering machine when you cannot answer phone calls, and set it to turn on after the fewest number of rings possible. A person with Alzheimer’s disease often may be unable to take messages or could become a victim of telephone exploitation. Turn ringers on low to avoid distraction and confusion. Put all portable and cell phones and equipment in a safe place so they will not be easily lost. w Install smoke alarms and carbon monoxide detectors in or near the kitchen and all sleeping areas. Check their functioning and batteries frequently. w Avoid the use of flammable and volatile compounds near gas appliances. Do not store these materials in an area where a gas pilot light is used. w Install secure locks on all outside doors and windows. w Hide a spare house key outside in case the person with Alzheimer’s locks you out of the house. w Avoid the use of extension cords if possible by placing lamps and appliances close to electrical outlets. Tack extension cords to the baseboards of a room to avoid tripping. w Cover unused electrical outlets with childproof plugs. w Place red tape around floor vents, radiators, and other heating devices to deter the person with Alzheimer’s from standing on or touching them when hot. w Check all rooms for adequate lighting. page 8


Home Safety for People with Alzheimer’s Disease

w Place light switches at the top and the bottom of stairs. w Stairways should have at least one handrail that extends beyond the first and last steps. If possible, stairways should be carpeted or have safety grip strips. Put a gate across the stairs if the person has balance problems. w Keep all medications (prescription and over-the-counter) locked. Each bottle of prescription medicine should be clearly labeled with the person’s name, name of the drug, drug strength, dosage frequency, and expiration date. Childresistant caps are available if needed. w Keep all alcohol in a locked cabinet or out of reach of the person with Alzheimer’s. Drinking alcohol can increase confusion. w If smoking is permitted, monitor the person with Alzheimer’s while he or she is smoking. Remove matches, lighters, ashtrays, cigarettes, and other means of smoking from view. This reduces fire hazards, and with these reminders out of sight, the person may forget the desire to smoke. w Avoid clutter, which can create confusion and danger. Throw out or recycle newspapers and magazines regularly. Keep all areas where people walk free of furniture. w Keep plastic bags out of reach. A person with Alzheimer’s disease may choke or suffocate. w Remove all guns and other weapons from the home or lock them up. Install safety locks on guns or remove ammunition and firing pins. w Lock all power tools and machinery in the garage, workroom, or basement. page 9


Home Safety for People with Alzheimer’s Disease

w Remove all poisonous plants from the home. Check with local nurseries or contact the poison control center (1-800-222-1222) for a list of poisonous plants. w Make sure all computer equipment and accessories, including electrical cords, are kept out of the way. If valuable documents or materials are stored on a home computer, protect the files with passwords and back up the files. Password protect access to the Internet, and restrict the amount of online time without supervision. Consider monitoring computer use by the person with Alzheimer’s, and install software that screens for objectionable or offensive material on the Internet. w Keep fish tanks out of reach. The combination of glass, water, electrical pumps, and potentially poisonous aquatic life could be harmful to a curious person with Alzheimer’s disease.

Outside Approaches to the House w Keep steps sturdy and textured to prevent falls in wet or icy weather. w Mark the edges of steps with bright or reflective tape. w Consider installing a ramp with handrails as an alternative to steps. w Eliminate uneven surfaces or walkways, hoses, and other objects that may cause a person to trip. w Restrict access to a swimming pool by fencing it with a locked gate, covering it, and closely supervising it when in use. w In the patio area, remove the fuel source and fire starters from any grills when not in use, and supervise use when the person with Alzheimer’s is present. page 10


Home Safety for People with Alzheimer’s Disease w Place a small bench or table by the entry door to hold parcels while unlocking the door. w Make sure outside lighting is adequate. Light sensors that turn on lights automatically as you approach the house may be useful. They also may be used in other parts of the home. w Prune bushes and foliage well away from walkways and doorways. w Consider a NO SOLICITING sign for the front gate or door.

Entryway w Remove scatter rugs and throw rugs. w Use textured strips or nonskid wax on hardwood and tile floors to prevent slipping.

Kitchen w Install childproof door latches on storage cabinets and drawers designated for breakable or dangerous items. Lock away all household cleaning products, matches, knives, scissors, blades, small appliances, and anything valuable. w If prescription or nonprescription drugs are kept in the kitchen, store them in a locked cabinet. w Remove scatter rugs and foam pads from the floor. w Install safety knobs and an automatic shut-off switch on the stove. w Do not use or store flammable liquids in the kitchen. Lock them in the garage or in an outside storage unit. page 11


Home Safety for People with Alzheimer’s Disease

w Keep a night-light in the kitchen. w Remove or secure the family “junk drawer.” A person with Alzheimer’s may eat small items such as matches, hardware, erasers, and plastics. w Remove artificial fruits and vegetables or food-shaped kitchen magnets, which might appear to be edible. w Insert a drain trap in the kitchen sink to catch anything that may otherwise become lost or clog the plumbing. w Consider disconnecting the garbage disposal. People with Alzheimer’s may place objects or their own hands in the disposal.

Bedroom w Anticipate the reasons a person with Alzheimer’s disease might get out of bed, such as hunger, thirst, going to the bathroom, restlessness, and pain. Try to meet these needs by offering food and fluids and scheduling ample toileting. w Use a night-light. w Use a monitoring device (like those used for infants) to alert you to any sounds indicating a fall or other need for help. This also is an effective device for bathrooms. w Remove scatter rugs and throw rugs. w Remove portable space heaters. If you use portable fans, be sure that objects cannot be placed in the blades. w Be cautious when using electric mattress pads, electric blankets, electric sheets, and heating pads, all of which can cause burns and fires. Keep controls out of reach. page 12


Home Safety for People with Alzheimer’s Disease

w If the person with Alzheimer’s disease is at risk of falling out of bed, place mats next to the bed, as long as they do not create a greater risk of accident. w Use transfer or mobility aids. w If you are considering using a hospital-type bed with rails and/ or wheels, read the Food and Drug Administration’s up-to-date safety information at www.fda.gov/cdrh/beds.

Bathroom w Do not leave a severely impaired person with Alzheimer’s alone in the bathroom. w Remove the lock from the bathroom door to prevent the person with Alzheimer’s from getting locked inside. w Place nonskid adhesive strips, decals, or mats in the tub and shower. If the bathroom is uncarpeted, consider placing these strips next to the tub, toilet, and sink. w Use washable wall-to-wall bathroom carpeting to prevent slipping on wet tile floors. w Use a raised toilet seat with handrails, or install grab bars beside the toilet. w Install grab bars in the tub/shower. A grab bar in contrasting color to the wall is easier to see. w Use a foam rubber faucet cover (often used for small children) in the tub to prevent serious injury should the person with Alzheimer’s disease fall.

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Home Safety for People with Alzheimer’s Disease

w Use a plastic shower stool and a handheld shower head to make bathing easier. w In the shower, tub, and sink, use a single faucet that mixes hot and cold water to avoid burns. w Set the water heater at 120 degrees Fahrenheit to avoid scalding tap water. w Insert drain traps in sinks to catch small items that may be lost or flushed down the drain. w Store medications (prescription and nonprescription) in a locked cabinet. Check medication dates and throw away outdated medications. w Remove cleaning products from under the sink, or lock them away. w Use a night-light. w Remove small electrical appliances from the bathroom. Cover electrical outlets. w If a man with Alzheimer’s disease uses an use electric razor, have him use a mirror outside the bathroom to avoid water contact.

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Home Safety for People with Alzheimer’s Disease

Living Room w Clear electrical cords from all areas where people walk. w Remove scatter rugs and throw rugs. Repair or replace torn carpet. w Place decals at eye level on sliding glass doors, picture windows, and furniture with large glass panels to identify the glass pane. w Do not leave the person with Alzheimer’s disease alone with an open fire in the fireplace. Consider alternative heating sources. w Keep matches and cigarette lighters out of reach. w Keep the remote controls for the television, DVD player, and stereo system out of sight.

Laundry Room w Keep the door to the laundry room locked if possible. w Lock all laundry products in a cabinet. w Remove large knobs from the washer and dryer if the person with Alzheimer’s tampers with machinery. w Close and latch the doors and lids to the washer and dryer to prevent objects from being placed in the machines.

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Home Safety for People with Alzheimer’s Disease

Garage/Shed/Basement w Lock access to all garages, sheds, and basements if possible. w Inside a garage or shed, keep all potentially dangerous items, such as tools, tackle, machines, and sporting equipment, either locked away in cabinets or in appropriate boxes or cases. w Secure and lock all motor vehicles and keep them out of sight if possible. Consider covering vehicles, including bicycles, that are not frequently used. This may reduce the possibility that the person with Alzheimer’s will think about leaving. w Keep all toxic materials, such as paint, fertilizers, gasoline, or cleaning supplies, out of view. Either put them in a high, dry place, or lock them in a cabinet. w If the person with Alzheimer’s is permitted in a garage, shed, or basement, preferably with supervision, make sure the area is well lit and that stairs have a handrail and are safe to walk up and down. Keep walkways clear of debris and clutter, and place overhanging items out of reach.

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Home Safety for People with Alzheimer’s Disease

Home Safety Behavior by Behavior Although a number of behavior and sensory problems may accompany Alzheimer’s disease, not every person will experience the disease in exactly the same way. As the disease progresses, particular behavioral changes can create safety problems. The person with Alzheimer’s may or may not have these symptoms. However, should these behaviors occur, the following safety recommendations may help reduce risks.

Wandering w Remove clutter and clear the pathways from room to room to prevent falls and allow the person with Alzheimer’s to move about more freely. w Make sure floors provide good traction for walking or pacing. Use nonskid floor wax or leave floors unpolished. Secure all rug edges, eliminate throw rugs, or install nonskid strips. The person with Alzheimer’s should wear nonskid shoes or sneakers. w Place locks high or low on exit doors so they are out of direct sight. Consider installing double locks that require a key. Keep a key for yourself, and hide one near the door for emergency exit purposes. w Use loosely fitting doorknob covers so that the cover turns instead of the actual knob. Due to the potential hazard they could cause if an emergency exit is needed, locked doors and doorknob covers should be used only when a caregiver is present. w Install safety devices found in hardware stores to limit how much windows can be opened. page 18


Home Safety for People with Alzheimer’s Disease w If possible, secure the yard with fencing and a locked gate. Use door alarms such as loose bells above the door or devices that ring when the doorknob is touched or the door is opened. w Divert the attention of the person with Alzheimer’s disease away from using the door by placing small scenic posters on the door; placing removable gates, curtains, or brightly colored streamers across the door; or wallpapering the door to match any adjoining walls. w Place STOP, DO NOT ENTER, or CLOSED signs on doors in strategic areas. w Keep shoes, keys, suitcases, coats, hats, and other signs of departure out of sight. w Obtain a medical identification bracelet for the person with Alzheimer’s with the words “memory loss” inscribed along with an emergency phone number. Place the bracelet on the person’s dominant hand to limit the possibility of removal, or solder the bracelet closed. Check with the local Alzheimer’s Association about the Safe Return program. w Place labels in garments to aid in identification. w Keep an article of the person’s worn, unwashed clothing in a plastic bag to aid in finding someone with the use of dogs. w Notify neighbors of the person’s potential to wander or become lost. Alert them to contact you or the police immediately if the individual is seen alone and on the move. w Give local police, neighbors, and relatives a recent photo of the person with Alzheimer’s, along with the person’s name and pertinent information, as a precaution should he or she become lost. Keep extra photos on hand. page 19


Home Safety for People with Alzheimer’s Disease w Consider making an up-to-date home video of the person with Alzheimer’s disease. w Do not leave a person with Alzheimer’s who has a history of wandering unattended.

Rummaging/Hiding Things w Lock up all dangerous or toxic products, or place them out of the person’s reach. w Remove all old or spoiled food from the refrigerator and cupboards. A person with Alzheimer’s may rummage for snacks but may lack the judgment or taste to rule out spoiled foods. w Simplify the environment by removing clutter or valuable items that could be misplaced, lost, or hidden by the person with Alzheimer’s disease. These include important papers, checkbooks, charge cards, and jewelry. w If your yard has a fence with a locked gate, place the mailbox outside the gate. People with Alzheimer’s often hide, lose, or throw away mail. If this is a serious problem, consider obtaining a post office box. w Create a special place for the person with Alzheimer’s to rummage freely or sort (for example, a chest of drawers, a bag of selected objects, or a basket of clothing to fold or unfold). Often, safety problems occur when the person with Alzheimer’s becomes bored or does not know what to do. w Provide the person with Alzheimer’s a safe box, treasure chest, or cupboard to store special objects. page 20


Home Safety for People with Alzheimer’s Disease

w Close access to unused rooms, thereby limiting the opportunity for rummaging and hiding things. w Search the house periodically to discover hiding places. Once found, these hiding places can be discreetly and frequently checked. w Keep all trash cans covered or out of sight. The person with Alzheimer’s disease may not remember the purpose of the container or may rummage through it. w Check trash containers before emptying them in case something has been hidden there or accidentally thrown away.

Hallucinations, Illusions, and Delusions Due to complex changes occurring in the brain, people with Alzheimer’s may see or hear things that have no basis in reality. Hallucinations involve hearing, seeing, smelling, or feeling things that are not really there. For example, a person with Alzheimer’s may see children playing in the living room when no children are there. Illusions differ from hallucinations because the person with Alzheimer’s is misinterpreting something that actually does exist. Shadows on the wall may look like people, for example. Delusions are false beliefs that the person thinks are real. For example, stealing may be suspected but cannot be verified. It is important to seek medical evaluation if a person with Alzheimer’s has ongoing disturbing hallucinations, illusions, or delusions. Discuss with the doctor any illnesses the person has and medicines he or she is taking. An illness or medicine may cause hallucinations or delusions. Often, these symptoms can be page 21


Home Safety for People with Alzheimer’s Disease treated with medication or behavior management techniques. With all of these symptoms, the following environmental adaptations also may be helpful. w Paint walls a light color to reflect more light. Use solid colors, which to an impaired person are less confusing than a patterned wall. Large, bold prints (for example, florals in wallpaper or drapes) may cause confusing illusions. w Make sure there is adequate lighting and keep extra bulbs handy in a secured place. Dimly lit areas may produce confusing shadows or difficulty with interpreting everyday objects. w Reduce glare by using soft light or frosted bulbs, partially closing blinds or curtains, and maintaining adequate globes or shades on light fixtures. w Remove or cover mirrors if they cause the person with Alzheimer’s disease to become confused or frightened. w Ask if the person can point to a specific area that is producing confusion. Perhaps one particular aspect of the environment is being misinterpreted. w Vary the home environment as little as possible to minimize the potential for visual confusion. Keep furniture in the same place. w Avoid violent or disturbing television programs. The person with Alzheimer’s may believe a story is real. w Do not confront the person with Alzheimer’s who becomes aggressive. Withdraw and make sure you have access to an exit as needed.

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Home Safety for People with Alzheimer’s Disease

Special Occasions/Gatherings/Holidays When celebrations, special events, or holidays include large numbers of people, remember that large groups may cause a person with Alzheimer’s disease some confusion and anxiety. The person with Alzheimer’s may find some situations easier and more pleasurable than others. w Large gatherings, weddings, family reunions, or picnics may cause anxiety. Consider having a more intimate gathering with only a few people in your home. Think about having friends and family visit in small groups rather than all at once. If you are hosting a large group, remember to prepare the person with Alzheimer’s ahead of time. Try to have a space available where he or she can rest, be alone, or spend some time with a smaller number of people, if needed. w Consider simplifying your holidays around the home, and remember that you already may have more responsibilities than in previous years. For example, rather than cooking an elaborate dinner at Thanksgiving or Christmas, invite family and friends for a potluck dinner. Instead of elaborate decorations, consider choosing a few select items to celebrate holidays. Make sure holiday decorations do not significantly alter the environment, which might confuse the person with Alzheimer’s disease.

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Home Safety for People with Alzheimer’s Disease

w Holiday decorations, such as Christmas trees, lights, or menorahs, should be secured so that they do not fall or catch on fire. Anything flammable should be monitored at all times, and extra precautions should be taken so that lights or breakable items are fixed firmly, correctly, and out of the way of those with Alzheimer’s disease. w As suggested by most manufacturers, candles of any size should never be lit without supervision. When not in use, they should be put away. w Try to avoid clutter in general, especially in walkways, during the holidays.

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Home Safety for People with Alzheimer’s Disease

Impairment of the Senses Alzheimer’s disease can cause changes in a person’s ability to interpret what he or she can see, hear, taste, feel, or smell. The person with Alzheimer’s should be evaluated periodically by a physician for any such changes that may be correctable with glasses, dentures, hearing aids, or other devices.

Vision People with Alzheimer’s may experience a number of changes in visual abilities. For example, they may lose their ability to comprehend visual images. Although there is nothing physically wrong with their eyes, people with Alzheimer’s may no longer be able to interpret accurately what they see because of brain changes. Also, their sense of perception and depth may be altered. These changes can cause safety concerns. w Create color contrast between floors and walls to help the person see depth. Floor coverings are less visually confusing if they are a solid color. w Use dishes and placemats in contrasting colors for easier identification. w Mark the edges of steps with brightly colored strips of tape to outline changes in height. w Place brightly colored signs or simple pictures on doors to important rooms (the bathroom, for example) for easier identification. w Be aware that a small pet that blends in with the floor or lies in walkways may be a hazard. The person with Alzheimer’s disease may trip over the pet. page 25


Home Safety for People with Alzheimer’s Disease

Smell A loss of or decrease in the sense of smell often accompanies Alzheimer’s disease. w Install smoke detectors and check them frequently. The person with Alzheimer’s disease may not smell smoke or may not associate it with danger. w Keep refrigerators clear of spoiled foods.

Touch People with Alzheimer’s may experience loss of sensation or may no longer be able to interpret feelings of heat, cold, or discomfort. w Set water heaters at 120 degrees Fahrenheit to avoid scalding tap water. Most hot water heaters are set at 150 degrees, which can cause burns. w Color code separate water faucet handles, with red for hot and blue for cold. w Place a sign on the oven, coffee maker, toaster, crock-pot, iron, and other potentially hot appliances that says DO NOT TOUCH or STOP! VERY HOT. The person with Alzheimer’s should not use appliances without supervision. Unplug appliances when not in use. w Use a thermometer to tell you if bath water is too hot or too cold. w Remove furniture or other objects with sharp corners or pad the corners to reduce potential for injury. page 26


Home Safety for People with Alzheimer’s Disease

Taste People with Alzheimer’s disease may lose taste sensitivity. As their judgment declines, they also may place dangerous or inappropriate things in their mouths. w Keep all condiments such as salt, sugar, or spices hidden if you see the person with Alzheimer’s using excess amounts. Too much salt, sugar, or spice can be irritating to the stomach or cause other health problems. w Remove or lock up medicine cabinet items such as toothpaste, perfume, lotions, shampoos, rubbing alcohol, and soap, which may look and smell like food to the person with Alzheimer’s. w Consider a childproof latch on the refrigerator, if necessary. w Keep the toll-free poison control number (1-800-222-1222) by the telephone. Keep a bottle of ipecac (vomit-inducing agent) available, but use only with instructions from poison control or 911. w Keep pet litter boxes inaccessible to the person with Alzheimer’s disease. Do not store pet food in the refrigerator. w Learn the Heimlich maneuver or other techniques to use in case of choking. Check with your local Red Cross chapter for more information and instruction. w If possible, keep a spare set of dentures. If the person keeps removing dentures, check for correct fit.

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Home Safety for People with Alzheimer’s Disease

Hearing People with Alzheimer’s disease may have normal hearing, but they may lose their ability to interpret what they hear accurately. This loss may result in confusion or overstimulation. w Avoid excessive noise in the home such as having the stereo and the TV on at the same time. w Be sensitive to the amount of noise outside the home, and close windows or doors, if necessary. w Avoid large gatherings of people in the home if the person with Alzheimer’s shows signs of agitation or distress in crowds. w If the person wears a hearing aid, check the batteries and functioning often.

Driving Driving is a complex activity that demands quick reactions, alert senses, and split-second decisionmaking. For a person with Alzheimer’s disease, driving becomes increasingly difficult. Memory loss, impaired judgment, disorientation, impaired visual and spatial perception, slow reaction time, certain medications, diminished attention span, and inability to recognize cues such as stop signs and traffic lights can make driving particularly hazardous. People with Alzheimer’s who continue to drive can be a danger to themselves, their passengers, and the community at large. As the disease progresses, they lose driving skills and must stop driving. page 28


Home Safety for People with Alzheimer’s Disease Unfortunately, people with Alzheimer’s often cannot recognize when they should no longer drive. This is a tremendous safety concern. It is extremely important to have the impaired person’s driving abilities carefully evaluated. Explaining to the person with Alzheimer’s disease that he or she can no longer drive can be extremely difficult. Loss of driving privileges may represent a tremendous loss of independence, freedom, and identity. It is a significant concern for the person with Alzheimer’s and the caregiver. The issue of not driving may produce anger, denial, and grief in the person with Alzheimer’s, as well as guilt and anxiety in the caregiver. Family and concerned professionals need to be both sensitive and firm. Above all, they should be persistent and consistent. The doctor of a person with Alzheimer’s disease can assist the family with the task of restricting driving. Talk with the doctor about your concerns. Most people will listen to their doctor. Ask the doctor to advise the person with Alzheimer’s to reduce his or her driving, go for a driving evaluation or test, or stop driving altogether. An increasing number of States have laws requiring physicians to report Alzheimer’s and related disorders to the Department of Motor Vehicles. The Department of Motor Vehicles then is responsible for retesting the at-risk driver. Testing should occur regularly, at least yearly. When dementia impairs driving and the person with Alzheimer’s disease continues to insist on driving, a number of different approaches may be necessary.

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Home Safety for People with Alzheimer’s Disease

w Work as a team with family, friends, and professionals, and use a single, simple explanation for the loss of driving ability such as: “You have a memory problem, and it is no longer safe to drive,” “You cannot drive because you are on medication,” or “The doctor has prescribed that you no longer drive.” w Ask the doctor to write on a prescription pad DO NOT DRIVE. Ask the doctor to write to the Department of Motor Vehicles or Department of Public Safety saying this person should no longer drive. Show the letter to the person with Alzheimer’s disease as evidence. w Offer to drive, or ask a friend or family member to drive. w Walk when possible, and make these outings special events. w Use public transportation or any special transportation provided by community organizations. Ask about senior discounts or transportation coupons. The person with Alzheimer’s should not take public transportation unsupervised. w Park the car at a friend’s home. w Hide the car keys. w Exchange car keys with a set of unusable keys. Some people with Alzheimer’s are in the habit of carrying keys. w Place a large note under the car hood requesting that any mechanic call you before doing work requested by the person with Alzheimer’s disease. w Have a mechanic install a “kill switch” or alarm system that disengages the fuel line to prevent the car from starting.

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Home Safety for People with Alzheimer’s Disease

Warning Signs of Unsafe Driving Often, the caregiver or a family member, neighbor, or friend is the first to become aware of the safety hazards of someone with Alzheimer’s behind the wheel. If the driver with Alzheimer’s disease experiences one or more of the following problems, it may be time to limit or stop driving. Does the person with Alzheimer’s: v get lost while driving in a familiar location? v fail to observe traffic signals? v drive at an inappropriate speed? v become angry, frustrated, or confused while driving? v make slow or poor decisions? Please do not wait for an accident to happen. Take action immediately!

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Home Safety for People with Alzheimer’s Disease w Consider selling the car and putting aside for taxi fares the money saved from insurance, repairs, and gasoline. w Do not leave a person with Alzheimer’s alone in a parked car.

Natural Disaster Safety Natural disasters come in many forms and degrees of severity. They seldom give warning, and they call upon good judgment and the ability to follow through with crisis plans. People with Alzheimer’s disease are at a serious disadvantage. Their impairments in memory and reasoning severely limit their ability to act appropriately in crises. It is always important to have a plan of action in case of fire, earthquake, flood, tornado, or other disasters. Specific home safety precautions may apply and environmental changes may be needed. The American Red Cross is an excellent resource for general safety information and preparedness guides for compre­hensive planning. If there is a person with Alzheimer’s in the home, the following precautions apply: w Get to know the neighbors, and identify specific individuals who would be willing to help in a crisis. Formulate a plan of action with them should the person with Alzheimer’s be unattended during a crisis. w Give neighbors a list of emergency phone numbers of caregivers, family members, and primary medical resources.

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Home Safety for People with Alzheimer’s Disease w Educate neighbors beforehand about the person’s specific disabilities, including inability to follow complex instructions, memory loss, impaired judgment, and probable disorientation and confusion. Give examples of some of the simple one-step instructions that the person may be able to follow. w Have regular emergency drills so that each member of the household has a specific task. Realize that the person with Alzheimer’s disease cannot be expected to hold any responsibility in the crisis plan and that someone will need to take primary responsibility for supervising the individual. w Always have at least an extra week’s supply of any medical or personal hygiene items critical to the person’s welfare, such as:

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food and water medications incontinence undergarments hearing aid batteries

w Keep an extra pair of the person’s eyeglasses on hand. w Be sure that the person with Alzheimer’s wears an identification bracelet stating “memory loss” should he or she become lost or disoriented during the crisis. Contact your local Alzheimer’s Association chapter and enroll the person in the Safe Return program. w Under no circumstances should a person with Alzheimer’s be left alone following a natural disaster. Do not count on the individual to stay in one place while you go to get help. Provide plenty of reassurance.

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Home Safety for People with Alzheimer’s Disease

 ho Would Take Care of the Person with W Alzheimer’s If Something Happened to You? It is important to have a plan in case of your own illness, disability, or death. w Consult a lawyer about setting up a living trust, durable power of attorney for health care and finances, and other estate planning tools. w Consult with family and close friends to decide who will take responsibility for the person with Alzheimer’s. You also may want to seek information about your local public guardian’s office, mental health conservator’s office, adult protective services, or other case management services. These organizations may have programs to assist the person with Alzheimer’s in your absence. w Maintain a notebook for the responsible person who will assume caregiving. Such a notebook should contain the following information:

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l

l

l

l

emergency phone numbers current problem behaviors and possible solutions ways to calm the person with Alzheimer’s assistance needed with toileting, feeding, or grooming favorite activities and foods

w Preview board and care or long-term care facilities in your community and select a few as possibilities. Share this information with the responsible person. If the person with Alzheimer’s disease is no longer able to live at home, the responsible person will be better able to carry out your wishes for long-term care.

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Home Safety for People with Alzheimer’s Disease

Conclusion Home safety takes many forms. This booklet focuses on the physical environment and specific safety concerns. But the home environment also involves the needs, feelings, and lifestyles of you the caregiver, your family, and the person with Alzheimer’s disease. Disability affects all family members, and it is crucial to maintain your emotional and physical welfare in addition to ensuring a safe environment. We encourage you to make sure you have quiet time, time out, and time to take part in something you enjoy. Protect your own emotional and physical health. Your local Alzheimer’s Association chapter can help you with the support and information you may need as you address this very significant checkpoint in your home safety list. You are extremely valuable. As you take on a commitment to care for a person with Alzheimer’s, please take on the equally important commitment to care for yourself.

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Home Safety for People with Alzheimer’s Disease

Additional Resources Several organizations offer caregivers information about Alzheimer’s disease. To learn more about support groups, services, research, and additional publications, you may wish to contact the following groups:

Alzheimer’s Disease Education and Referral (ADEAR) Center P.O. Box 8250 Silver Spring, MD 20907-8250 1-800-438-4380 (toll-free) www.nia.nih.gov/alzheimers The National Institute on Aging’s ADEAR Center offers information and publications for families, caregivers, and professionals on diagnosis, treatment, patient care, caregiver needs, long-term care, education and training, and research related to Alzheimer’s disease. Staff members answer telephone, email, and written requests and make referrals to local and national resources. The ADEAR website offers free, online publications in English and Spanish; email alert and online Connections newsletter subscriptions; an Alzheimer’s disease clinical trials database; and more.

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Alzheimer’s Association 225 North Michigan Avenue, Floor 17 Chicago, IL 60601-7633 1-800-272-3900 (toll-free) 1-866-403-3073 (TDD/toll-free) www.alz.org The Alzheimer’s Association is a national nonprofit association with a network of local chapters that provide education and support for people diagnosed with Alzheimer’s disease, their families, and caregivers. The Association also supports research on Alzheimer’s.

Alzheimer’s Foundation of America 322 Eighth Avenue, 7th Floor New York, NY 10001 1-866-232-8484 (toll-free) www.alzfdn.org The Alzheimer’s Foundation of America provides care and services to individuals confronting dementia and to their caregivers and families through member organizations dedicated to improving quality of life. Services include a toll-free hotline, consumer publications and other educational materials, and conferences and workshops.

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Home Safety for People with Alzheimer’s Disease

American Red Cross 2025 E Street, NW Washington, DC 20006 1-800-733-2767 www.redcross.org The Red Cross offers health information, health services, disaster relief, and emergency services to the public. Local chapters provide programs for older people, including safety courses and home nurse care instruction.

Eldercare Locator 1-800-677-1116 (toll-free) www.eldercare.gov Eldercare Locator is a nationwide directory-assistance service helping older people and their caregivers locate local support and resources. It is funded by the U.S. Administration on Aging, whose website at www.aoa.gov also features Alzheimer’s information for families, caregivers, and healthcare professionals.

Family Caregiver Alliance 785 Market Street, Suite 750 San Francisco, CA 94103 1-800-445-8106 (toll-free) www.caregiver.org The Family Caregiver Alliance is a nonprofit organization that offers support services and information for people caring for adults with Alzheimer’s, stroke, traumatic brain injuries, and other cognitive disorders.

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Well Spouse Association 63 West Main Street, Suite H Freehold, NJ 07728 1-800-838-0879 (toll-free) www.wellspouse.org This nonprofit organization gives support to spouses and partners of people who are chronically ill and/or disabled. It offers support groups and a newsletter.

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The National Institute on Aging gratefully acknowledges the caring staff of the Alzheimer’s Disease Research Center at the University of California, San Diego, and the Alzheimer’s Association of San Diego, who shared their valuable advice, experience, and expertise to create this booklet. Contact the ADEAR Center for additional Alzheimer’s disease information, including the free publication Caring for a Person with Alzheimer’s Disease: Your Easy-to-Use Guide from the National Institute on Aging.

Alzheimer’s Disease Education and Referral (ADEAR) Center 1-800-438-4380 www.nia.nih.gov/alzheimers The ADEAR Center is a service of the National Institute on Aging National Institutes of Health


U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Institute on Aging NIH Publication No. 02-5179 August 2010


Alzheimer's Home Safety